Healthcare Provider Details

I. General information

NPI: 1568305324
Provider Name (Legal Business Name): KNELA TRACY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 WESTBOURNE DR
CINCINNATI OH
45248-5133
US

IV. Provider business mailing address

109 BEECHGROVE AVE
BATESVILLE IN
47006-1414
US

V. Phone/Fax

Practice location:
  • Phone: 513-922-0123
  • Fax:
Mailing address:
  • Phone: 773-962-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberIL.03592
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: